1. Chapter 1 with Bradley, Juan, Mary, Angela and Zak What are the contributing factors to poor health? Is it based on Ethnicity? Are some groups of people more prone to certain health issues and diseases than others? Is it a lack of knowledge/education, culture or income?

2. Asian American Culture

3. Physical Health Concerns  Tuberculosis, anemia, hypertension, hepatitis B (50% death rate)  Tobacco use (men): Laotians (92%), Cambodians (71%), Vietnamese (65%)  Don’t seek medical care or preventative measures  TCM, CHM, acupuncture  Late diagnosis: #1 cause of death is cancer  Language barrier and communication difficulties

4. Socioeconomic Barriers  Model Minority Myth (limits individualism)  Asian Americans living below poverty: 12.6% (U.S. average: 12.4%)  2 million AAs without health insurance  Small businesses, lack of skills/education  1/5 Asian American households = “linguistically isolated” (> age 14)  1/10 U.S. born AAs = limited English proficiency Source: AAPIP

5. Mental Health  Parental expectations and pressure to succeed  Traditional belief system: lack of harmony (emotions) & evil spirits  Least likely to utilize mental health services  Social stigma, shame & saving face  Depression, anxiety disorders, suicide  Ages 15-24 and >65, Asian females = highest rate of suicide Source: CDC, 2012. High School Youth Risk Behavior Survey Data

6. From Broken Homes to a Broken System https://youtu.be/Hdt9ZBQy7WM

7. Issues Facing Native American Teens: Historical Context Indian Health Service (IHS): provides federal health services to Native peoples. Bureau of Indian Affairs (BIA): responsible for management of Native held land. Bureau of Indian Education (BIE): Provides educational opportunities and funding to primary/secondary schools.

8. Major Issues Facing All Native Americans 1.Native American poverty rate: 23.6% 2.12% of homes lack safe water and sanitation 3.24% lack health insurance 4.50% High School graduation rate 5.13.3% undergraduate degree

9. Major Concerns for Native American Youth Compared to National Averages: 1.Suicide Prevention: 4 times higher in males, 11 times higher in females 2.Obesity and Diabetes: 177% higher incidence of diabetes 3.Substance/Drug Abuse: 514% higher incidence of alcohol mortality 4.Violence: 15% of NA Teens participate in Gang Activity

10. Hispanic Americans (Demographics) - 54 million Hispanics live in the United States - Hispanics account for 17% of the U.S. population - California has 14.7 million Hispanic Americans - Only 6.8% of college students are Hispanic - 29.1% of Hispanics lack health insurance

11. Life Expectancy of Hispanic Americans (2013) - Hispanic men on average live 79.1 years. - White men on average live 76.5 years. - Hispanic women on average live 83.8 years. - White women on average live 81.2 years. Source: CDC, Health United States, 2014. Table 16.

12. Death Rate in 2010 Age-adjusted Death Rate per 100,000 population Death Rate in 2013 Cause of Death Hispanic Men/Wome n Non-Hispanic White Men/Women Diseases of heart 132.8179.9 Diabetes mellitus 27.118.2 Unintentional injury 25.842.4 Suicide5.915.0 Cause of Death Hispanic Men/Women Non-Hispanic White Men/Women Diseases of heart 121.2171.8 Diabetes mellitus 26.318.6 Unintentional injury 26.944.2 Suicide5.715.9 Source: CDC, Health United States, 2014. Table 18.

13. New cancer cases per 100,000 population Men (2011)Women (2011) Cancer Hispanic Men Non-Hispanic White Men All Sites385.6518.1 Prostate108.1134.0 Lung35.263.5 Colon42.643.4 Cancer Hispanic Women Non-Hispanic White Women All Sites322.5433.5 Breast95.0137.0 Lung23.450.2 Colon28.834.2 Source: CDC, Health United States, 2014. Table 40.

14. African American Health All Ages (2013) Number of AA: 40.8 million (about 13% of population) Smoking: 22.7% males, 15.2% females Obesity: 37.9% males, 57.6% females Hypertension: 39.9% males, 44.5% females Leading Causes of Death: Heart Disease, Cancer, Stroke HIV/AIDS: 49% of reported cases

15. African American Youth Health Risk (2010) 1.Ages 2-19 16.9% obese or 1 in 6, 14.8% overweight 2.Among AA children, 11.4% of those ages 2-5 are obese. 3.Last 20 years, ages 12-19 obesity grew 10.5% to 18.1%. 4.In AA, obesity rates grew from 13.4% to 24.4% 5.2008, AA ages 12-19: 29.9% obese (highest rate of any age, gender& ethnicity)

16. Socioeconomic Status in African Americans 1.AA children are 3x more likely to live in poverty than Caucasian children. (2007) 2.Unemployment rates for AA are typically double those of Caucasians (2008) 3.AA men working full time earn 72% of the average earnings of Caucasian men and 85% of Caucasian women. (2008)

17. Uninsured Americans

18. ethnicity % of Uninsured % of two parent households % in poverty% with BA Asian Americans 18%n/a12%50% Native Americans 29.2%57%28.4%13% Hispanic Americans 29.1%65.1%25.6%13.8% African Americans 30%44%27.4%18% Is it ethnicity? Family structure?

20. Quiz for Snacks What factors are contributing to the health risks for minorities? - Is it income? - Lack of health insurance? - Families without two parents? - Demographics?

21. Sources cdc.gov factfinder.census.gov census.gov Horwitz, Sari. “From Broken Homes to a Broken System.” Washington Post. November 28, 2014. http://www.washingtonpost.com/sf/national/2014/11/28/from- broken-homes-to-a-broken-system/ http://www.washingtonpost.com/sf/national/2014/11/28/from- broken-homes-to-a-broken-system/ “Native American Youth 101: Information on the Historical Context and Current Status of Indian Country and Native American Youth”. The Aspen Institute. 2012. http://www.aspeninstitute.org/sites/default/files/content/upload/ Native%20American%20Youth%20101_higres.pdf http://www.aspeninstitute.org/sites/default/files/content/upload/ Native%20American%20Youth%20101_higres.pdf http://www.cahperd.org/cms-assets/documents/28168- 686161.overweightobesityafricanameryouth.pdf http://www.cdc.gov/nchs/fastats/black-health.htm https://www.whitehouse.gov/administration/eop/aapi /data/critical-issues http://www.aahiinfo.org/english/asianAmericans.php Kramer EJ, Kwong K, Lee E, Chung H. Cultural factors influencing the mental health of Asian Americans. Western Journal of Medicine. 2002;176(4):227-231. http://talkpoverty.org/2015/05/12/unspoken- problem-language-barriers-poverty-aapi- community/4 http://www.apa.org/pi/ses/resources/publications/fac tsheet-erm.aspx